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Hypospadias, Urethral Fistula, and Other Abnormalities of the "Hole" (or Holes) of the Penis

Not every guy has his hole in the penis in the same place. There are several conditions that can result in a man having an unusual penile anatomy.

Hypospadias is a condition in which the opening doesn't form at the tip of the penis. A boy may be born with the opening at the bottom of the glans or head of the penis, or along the shaft of the penis, or even at the scrotum. This happens to about 3 in 1000 male babies. It's usually corrected by surgery while the boy is an infant so both urine and semen are emitted where you would expect them to be. (Ordinarily the surgery would not result in urine coming out a top hole and semen coming out a lower hole.)

Hypospadias is usually corrected with a single surgical procedure that is completed in a boy's first year of life. If something doesn't go completely right with the surgery and only shows up after puberty, most guys won't ask their parents or their doctors to take a look. Guys who have hypospadias also tend to get curvatures of the penis and balls that don't descend. It's a good idea to talk with a urologist if problems show up when you become sexually active.

Urethral fistulas can also result in two openings in the penis. This is a "second hole" that results from surgery or an injury. Usually if a guy has a second hole in his penis, it's due to something left undone or some complication of his surgery for hypospadias. It can also be a complication of surgery for chordee, a bending of the penis during erection. However, a "dimple" left by successful surgery is just that, a dimple. It won't leak urine or squirt semen.

Even baby boys can get erections. If their erections point sideways, this may be a sign of chordee. If the condition is noticed and treated before the age of two, the surgery is a very simple procedure that doesn't even require a hospital stay. If the condition is only diagnosed after a man is an adult, it may require multiple surgeries and multiple hospital stays.

Chordee may be associated with other problems:

Wandering raphe. The raphe is the midline of the penis. Sometimes it can tug the penis so that erections are bent and/or the urine stream goes sideways.

Skin tethering. Sometimes the skin around the opening of the penis is paper-thin and prone to tearing and bleeding, especially during sex.

Webbed penis (penoscrotal fusion). The underside of the penis can be "stuck" to the scrotum, making an upward-pointing erection impossible.

Dorsal hood. In this condition the foreskin only covers the top part of the penis (even before circumcision).

Where surgical correction of chordee gets tricky is if the patient has had a circumcision. Often the surgeon needs the foreskin to repair other parts of the penis. If the foreskin has already been removed, it's more difficult to repair the penis. Or if the foreskin has been removed in a religious ceremony, the religious official doing the circumcision may not pay attention to the problems that the procedure will produce. (Observant Jews may use a rabbi called a mohel, although modern Muslims will send their boys to a doctor.)

How do these conditions affect a man's sex life?

They don't interfere with fertility. Sperm production (in the testes) and semen production (in the prostate) go on unaffected by penile anatomy.

They may affect a man's response from his first sex partner. Most parents don't discuss these issues with their sons. They leave their sons to discover them on their own.

Men who can have erections can have mutually satisfying sex. When the first sex partner has experience with other guys, there can be a certain amount of bewilderment, or rejection, or excitement about trying something new.